Healthcare Provider Details

I. General information

NPI: 1003677394
Provider Name (Legal Business Name): ALANNAH ROSE DEUSENBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 01/23/2024
Certification Date: 01/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 HARRISON AVE
ELKINS WV
26241-3325
US

IV. Provider business mailing address

60 SHAMROCK DR
BUCKHANNON WV
26201-3204
US

V. Phone/Fax

Practice location:
  • Phone: 304-636-4390
  • Fax:
Mailing address:
  • Phone: 681-298-1265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: